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Among those with medullary thyroid carcinoma (MTC), lymph node dissection seemed to decrease local recurrences.

Note that guidelines from the American Thyroid Association recommend all patients with known MTC undergo surgery to remove not only the entire thyroid gland, but also the lymph nodes in the central compartment of the neck.

Among those with medullary thyroid carcinoma (MTC), lymph node dissection seemed to decrease local recurrences, according to researchers.

During the initial operation for patients diagnosed with MTC, central and lateral neck dissection was tied to a decreased risk of reoperation (HR 0.53, 95% CI 0.30-0.93), reported Eric J. Kuo, MD, of the University of California Los Angeles (UCLA), and colleagues.

A higher risk of reoperation was associated with lymph node metastasis (HR 3.43, 95% CI 2.00-5.90), they wrote in JAMA Surgery.

"It is well known that medullary thyroid cancer spreads to the neck lymph nodes early," co-author Masha J. Livhits, MD, also of UCLA, told MedPage Today. "Once it has spread, it can be difficult to cure surgically and a significant number of patients require reoperation for recurrent thyroid cancer."

Despite this recommendation, only around a third of the study's patients actually underwent a central neck dissection during the initial thyroidectomy (35.5%, 216 of 609 patients).

Livhits said the authors were surprised to see such a low rate of lymph node dissection during at the initial operation. "This represents a low rate of adherence to the ATA guidelines, and it is an opportunity for the medical community to improve our care of patients with medullary thyroid cancer."

The retrospective analysis assessed 609 people in the California Cancer Registry -- a system that tracks all cancer diagnoses in the state -- and the Office of Statewide Health Planning and Development in California, which houses all inpatients and ambulatory surgery reports. All individuals had MTC and were at least 2 years postoperative from thyroid surgery.

There was a 16.3% rate of reoperation among the cohort (99 of 609), with a median time of 6.4 months to surgery. Reoperation was defined as central neck dissection, lateral neck dissection, thyroid lobectomy, totally thyroidectomy with or without central neck dissection, and totally thyroidectomy with or without lateral neck dissection, occurring beyond 30 days after index operation.

The authors noted that it was assumed those who reported lateral neck dissection also experienced central neck dissection. Nearly half of individuals who underwent reoperation were free of disease during a median follow-up of 7.7 years (45.5%, 45 of 99).

In an accompanying commentary, Jessica E. Gosnell, MD, and Quan-Yang Duh, MD, both of the University of California San Francisco, highlighted some of the major takeaways of this study. First, "fair proportion of affected patients are not getting [the recommended] operations" currently outlined in the guidelines," they noted.

They stressed that reoperations were not tied to increased mortality, which therefore implies that "even patients with recurrent and metastatic MTC can be treated with repeated reoperations and still live full and active lives," and that complications associated with such treatment should be minimized.

In regards to future research, Livhits told MedPage Today her group is interested to see if adherence to the ATA's guidelines improves within the next 5 to 10 years.

Click here for the American Association of Clinical Endocrinologists' clinical practice guidelines for the management of thyroid carcinoma.

The study was supported by the H & H Lee Research Program.

Kuo, Livhits, and co-authors, as well as Gosnell and Duh, disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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